Many of the significant challenges we face in public health require that individuals change their behavior as part of the solution. Barriers to behavior change, whether known or unidentified, compound these challenges even more. As guest editors of this issue, we propose that the complementary use of social ecological theory and robust social marketing practice offers significant promise to overcome these impediments to improving the public's health.

We know that people make decisions—healthy or not—within the context of the social and cultural environment in which they live. If people cannot find a safe environment in which to exercise, they probably won't. If they cannot afford fresh fruits and vegetables, they can't eat them. If condoms are socially unacceptable, they won't be used. Social ecological theory is one important framework that offers insight into how and why these behaviors occur. The theory identifies multiple levels of influence (intrapersonal, interpersonal, social, environmental, and institutional)1 and employs a variety of disciplines and perspectives in an effort to understand and address complex public health problems.

Social marketing is an applied approach that fits well within this theoretical perspective. The approach uses strategies from commercial marketing, but focuses on how consumers interact with services and products that promote health. The fundamental axiom in social marketing is the notion of voluntary exchange: that individuals adopt products, ideas and behaviors from which they expect to benefit.2 The combined approaches of social marketing and social ecological theory focusing on people and places can result in stronger and more permanent behavior changes.

Methods Quantitative content analysis of 901 articles about MUP published in 10 UK and Scottish newspapers between 2005 and 2012.

Results MUP was a high-profile issue, particularly in Scottish publications. Reporting increased steadily between 2008 and 2012, matching the growing status of the debate. The alcohol problem was widely acknowledged, often associated with youths, and portrayed as driven by cheap alcohol, supermarkets and drinking culture. Over-consumption was presented as a threat to health and social order. Appraisals of MUP were neutral, with supportiveness increasing slightly over time. Arguments focused on health impacts more frequently than more emotive perspectives or business interests. Health charities and the NHS were cited slightly more frequently than alcohol industry representatives.

Conclusion Emphases on efficacy, evidence and experts are positive signs for evidence-based policymaking. The high profile of MUP, along with growing support within articles, could reflect growing appetite for action on the alcohol problem. Representations of the problem as structurally driven might engender support for legislative solutions, although cultural explanations remain common.

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although Americans’ life expectancy and health have improved over the past century, these gains have lagged behind those in other high-income countries. This health disadvantage prevails even though the United States spends far more per person on health care than any other nation. To gain a better understanding of this problem, the National Institutes of Health (NIH) asked the National Research Council and the Institute of Medicine to convene a panel of experts to investigate potential reasons for the U.S. health disadvantage and to assess its larger implications. The panel’s findings are detailed in its report, U.S. Health in International Perspective: Shorter Lives, Poorer Health.

Nearly half (46 percent) healthcare professionals say that they will introduce mobile apps to their practice in the next five year, according to the Plano, Tex.-based Research Now Group.

The survey included 500 healthcare professionals and 1,000 health app users in the U. S. Healthcare professionals were asked whether they currently use smartphone technology in their medical practice; whether they thought it was beneficial and for which types of patients; and under what conditions they thought it had the greatest potential. The health app users were asked which types of apps they use and how they feel about using smartphone technology in relation to their health.

The research found that 86 percent of healthcare professionals believe that health apps will increase their knowledge of patients' conditions. What’s more, 96 percent of users think that health apps help to improve their quality of life, and 72 percent of healthcare professionals believe that health apps will encourage patients to take more responsibility for their health.

The observed clustering, and shared underlying determinants, of risk behaviours in young people has led to the proposition that interventions should take a broader approach to risk behaviour prevention. In this review we synthesized the evidence on ‘what works’ to prevent multiple risk behaviour (focusing on tobacco, alcohol and illicit drug use and sexual risk behaviour) for policy-makers, practitioners and academics. We aimed to identify promising intervention programmes and to give a narrative overview of the wider influences on risk behaviour, in order to help inform future intervention strategies and policies. The most promising programme approaches for reducing multiple risk behaviour simultaneously address multiple domains of risk and protective factors predictive of risk behaviour. These programmes seek to increase resilience and promote positive parental/family influences and/or healthy school environments supportive of positive social and emotional development. However, wider influences on risk behaviour, such as culture, media and social climate also need to be addressed through broader social policy change. Furthermore, the importance of positive experiences during transition periods of the child–youth–adult phase of the life course should be appropriately addressed within intervention programmes and broader policy change, to reduce marginalization, social exclusion and the vulnerability of young people during transition periods.

In reply My coauthors and I appreciate the interest of Drs Engelman and Mattes in our recent publication on dietary sodium intake and risk of congestive heart failure.1 We agree with them on the limitations of dietary data from the NHANES I Epidemiologic Follow-up Study (NHEFS). However, we do...

‘Promoting Health and Equity’ is the theme of the 22nd International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion taking place in Curitiba, Brazil, on May 22–26, 2016 (1). Some may say that as themes go, this one is tired, even stale, and that we could have chosen something more contemporary and more in step with current challenges faced by health promotion, such as the impact of climate change or the role of emerging technology. To such contentions I would respond that at this time, there is no more pressing issue for health promotion than that of promoting equity. I offer three arguments in defence of this choice. Firstly, the social inequalities that underpin health inequity are not disappearing; they are growing. Secondly, while the promotion of health equity has achieved a certain level of popularity in the field of public health, commitment to addressing the issue remains fragile. Thirdly, the public health engagement toward addressing the social determinants of health is increasingly being called into question by governments – re-centring this fundamental objective is therefore a matter of survival.

Many in the global health community have recently proposed that current efforts be expanded to include diseases typically associated with advanced economies, such as heart disease, mental health disorders, diabetes, and cancers. Here, we discuss ways in which the National Cancer Institute’s newly formed Center for Global Health plans to stem the rising cancer burden in developing countries.

Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture). In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening. We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice.

We want to know. And we want to know now. Gone are the days of anxiously waiting for a doctor to physically diagnose us. We see the slightest inkling of an unknown symptom and we hop online. Why wait, when we don’t have to?

77% of online health seekers say they began their last session at a search engine such as Google, Bing, or Yahoo

72% of internet users say they looked online for health information within the past year

Behind using search engines and checking email, the #3 activity people do online is search for health information

The instant anyone suspects a symptom, they can turn to the web for more information. Obviously, this has led to an increase in the number of web users taking it upon themselves to diagnose their own symptoms and seek available treatments online.

There emerges a pattern in the way people search for health-related information. Each web user follows a similar patient search process while deciding if they need professional help. Understanding this path is invaluable to your healthcare marketing team. Although finding the ideal marketing balance between these four phases may take time, there are steps you can take right now to ensure that, at the very least, you’re engaging these searchers appropriately with your branded digital assets.

Simply put, social media hashtags are designed to enable search on social channels. First coming to prominence on Twitter in 2007 in order to combat the short lifespan of a tweet, hashtags are used to identify a trending topic or specific subject so that interested people can find it, no matter where it appears in the tweet stream. And given that Twitter is all about conversation, hashtags also facilitate interaction between like-minded people with common interests.

From a marketing perspective, where social media is considered the primary channel for communication, ensuring the visibility and longevity of a campaign or brand message can be a problem. The popularity of Twitter and its ‘real-time’ reporting, as well as the cumulative nature of following and tweet interaction produces a barrage of tweets. Today, an average of8566 tweets per secondwere published on Twitter.

So how can a healthcare brand ensure its message is seen and heard? Repetition is one answer, but such a strategy carries with it the potential downside of alienating and losing brand advocates and followers. Advertising is another, but it has obvious cost implications. Using hashtags is not only more cost-effective, but also more productive in attracting and engaging with an interested audience, and in prolonging the lifespan of tweets and social posts. A study by Buddy Media found that using hashtags in tweets can double engagement[1].

A prime example of the importance of hashtag use within healthcare is theHealthcare Hashtag Project. Set up in 2010 by Symplur, this project aims to make the use of Twitter more accessible for providers and the healthcare community as a whole. The project maintains a database of relevant hashtags, and encourages submission of new hashtags in order to facilitate the exploration of healthcare subject matter on social media. Results to date are impressive. Its most famous healthcare hashtag,#hcsmeu, receives an average of 290k impressions in a single day.

Just as social media is transforming healthcare, hashtags are transforming healthcare marketing. Online community discussions, Tweetchats, real-time conversation, events, trending topics and much more are all powered by hashtags, not only on Twitter but also on other social channels.

- See more at: http://www.eurocomhealthcare.com/why-use-hashtags-in-healthcare-campaigns/#sthash.A1KFEs9X.dpuf

The lesbian, gay, bisexual, transgender/transsexual, queer/questioning and intersex (LGBTQI) population has been largely understudied by the medical community. Researchers found that the LGBTQI community experience health disparities due to reduced access to health care and health insurance, coupled with being at an elevated risk for multiple types of cancer when compared to non-LGBTQI populations.

For patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases. Using statewide facility discharge data for California in 2009, we identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. We mapped amputations based on residential ZIP codes and used data from the Census Bureau to produce corresponding maps of poverty rates. Comparisons of the maps show amputation “hot spots” in lower-income urban and rural regions of California. Prevalence-adjusted amputation rates varied tenfold between high-income and low-income regions. Our analysis does not support detailed causal inferences. However, our method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.

A UK health regulator has issued a warning to makers of mobile medical “apps” that may harm patients.

Neil McGuire, clinical director of devices at the Medicines and Healthcare Products Regulatory Agency (MHRA) said, “Be under no illusion—if you have a medical device and it’s software or an app and patients come to grief, we’re coming looking.”

McGuire spoke at a health technologies seminar in London on 18 March attended by NHS and private sector representatives including device developers and designers. He was asked whether the United Kingdom and Europe would follow the US Food and Drug Administration’s lead in taking a supposedly “softer” line on certain classes of devices in guidance issued last …

Background Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking. Methods Record-linkage cohort study of 1.93 million people to examine the association between small-area socioeconomic deprivation and 12 CVDs. Health records covered primary care, hospital admissions, a myocardial infarction registry and cause-specific mortality in England (CALIBER). Patients were aged ≥30 years and were initially free of CVD. Cox proportional hazard models stratified by general practice were used. Findings During a median follow-up of 5.5 years 114,859 people had one of 12 initial CVD presentations. In women the hazards of all CVDs except abdominal aortic aneurysm increased linearly with higher small-area socioeconomic deprivation (adjusted HR for most vs. least deprived ranged from 1.05, 95%CI 0.83–1.32 for abdominal aortic aneurysm to 1.55, 95%CI 1.42–1.70 for heart failure; I 2 = 81.9%, τ 2 = 0.01). In men heterogeneity was higher (HR ranged from 0.89, 95%CI 0.75–1.06 for cardiac arrest to 1.85, 95%CI 1.67–2.04 for peripheral arterial disease; I 2 = 96.0%, τ 2 = 0.06) and no association was observed with stable angina, sudden cardiac death, subarachnoid haemorrhage, transient ischaemic attack and abdominal aortic aneurysm. Lifetime risk difference between least and most deprived quintiles was most marked for peripheral arterial disease in women (4.3% least deprived, 5.8% most deprived) and men (4.6% least deprived, 7.8% in most deprived); but it was small or negligible for sudden cardiac death, transient ischaemic attack, abdominal aortic aneurysm and ischaemic and intracerebral haemorrhage, in both women and men. Conclusions Associations of small-area socioeconomic deprivation with 12 types of CVDs were heterogeneous, and in men absent for several diseases. Findings suggest that policies to reduce deprivation may impact more strongly on heart failure and peripheral arterial disease, and might be more effective in women.

Access to safe, legal abortion services is essential to women’s health and central to women’s ability to participate equally in the economic and social life of the United States.

(2)

Access to safe, legal abortion services has been hindered in the United States in various ways, including blockades of health care facilities and associated violence; restrictions on insurance coverage; restrictions on minors’ ability to obtain services; and requirements and restrictions that single out abortion providers and those seeking their services, and which do not further women’s health or the safety of abortion, but harm women by reducing the availability of services.

(3)

In the early 1990s, protests and blockades at health care facilities where abortions were performed, and associated violence, increased dramatically and reached crisis level, requiring Congressional action. Congress passed the Freedom of Access to Clinic Entrances Act (Public Law 103–259) to address that situation and ensure that women could physically access abortion services.

Among a cohort of older adults in the Health ABC Study, this study finds that food frequency questionnaire–assessed sodium intake was not associated with 10-year mortality, incident cardiovascular disease, or incident heart failure.

National cancer control plans are needed to stem the rapidly rising global cancer burden. Prevention and early detection are complementary but distinct strategies for cancer control. Some cancers are prevented through behavior and/or environmental modifications that reduce cancer risk, whereas other cancers are more amenable to treatment when they are successfully diagnosed at early stages. Prevention and early detection strategies should be prioritized on the basis of country-specific cancer demographics, modifiable risk factor distribution, and existing treatment resource availability. Following an individualized plan integrating prevention and early detection strategies, deficits can be targeted to strengthen national health systems for cancer control.

Background Health in All Policies (HiAP) is a form of intersectoral action that aims to include the promotion of health in government initiatives across sectors. To date, there has been little study of economic considerations within the implementation of HiAP.Methods

As part of an ongoing program of research on the implementation of HiAP around the world, we examined how economic considerations influence the implementation of HiAP. By economic considerations we mean the cost and financial gain (or loss) of implementing a HiAP process or structure within government, or the cost and financial gain (or loss) of the policies that emerge from such a HiAP process or structure. We examined three jurisdictions: Sweden, Quebec and South Australia. Semi-structured telephone interviews were conducted with 12 to 14 key informants in each jurisdiction. Two investigators separately coded transcripts to identify relevant statements.

Results

Initial readings of transcripts led to the development of a coding framework for statements related to economic considerations. First, economic evaluations of HiAP are viewed as important for prompting HiAP and many forms of economic evaluation were considered. However, economic evaluations were often absent, informal, or incomplete. Second, funding for HiAP initiatives is important, but is less important than a high-level commitment to intersectoral collaboration. Furthermore, having multiple sources of funding of HiAP can be beneficial, if it increases participation across government, but can also be disadvantageous, if it exposes underlying tensions. Third, HiAP can also highlight the challenge of achieving both economic and social objectives.

Conclusions

Our results are useful for elaborating propositions for use in realist multiple explanatory case studies. First, we propose that economic considerations are currently used primarily as a method by health sectors to promote and legitimize HiAP to non-health sectors with the goal of securing resources for HiAP. Second, allocating resources and making funding decisions regarding HiAP are inherently political acts that reflect tensions within government sectors. This study contributes important insights into how intersectoral action works, how economic evaluations of HiAP might be structured, and how economic considerations can be used to both promote HiAP and to present barriers to implementation.

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